The impact of junior doctors’ worktime arrangements on their fatigue and well-being

Tucker, Philip; Brown, Menna; Dahlgren, Anna; Davies, Gwyneth; Ebden, P; Folkard, Simon; Hutchings, Hayley; Åkerstedt, Torbjörn

doi:10.5271/sjweh.2985

Cited by 65 publications

(45 citation statements)

References 22 publications

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“…Performing the same amount of work in fewer hours (work compression) is of concern regarding workload44 and overall well-being,45 and may place trainee doctors at risk of burnout 46. Although much of the literature relating to fatigue comes from the USA where restricted working hours are still much longer than in Europe (eg, 80 h/week and longer maximum shift lengths), two UK self-report studies conducted shortly after implementation of the 48 h working week have highlighted the effect of different schedules on fatigue, including the negative effect of working 7 consecutive nights, having only 1 day of rest after night shifts, intervals of less than 10 h between shifts, and shifts of 12 consecutive days 30 31. Difficulty achieving naps during night shifts, and poor provision for naps, has been reported elsewhere 33.…”

Section: Discussionmentioning

confidence: 99%

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

et al. 2014

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ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors’ experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.Setting9 deaneries in all four UK nations; secondary care.Participants82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.ResultsImplementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.ConclusionsLong-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors’ true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.

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Section: Discussionmentioning

confidence: 99%

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

et al. 2014

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“…The trainees had to complete the course in their spare time, and weekly work hours > 48 h for junior doctors are associated with work-life interference [27]. The European Working Time Directive (EWTD) has made standards for weekly work hours for junior doctors to limit incidents at work [28].…”

Section: Discussionmentioning

confidence: 99%

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion

et al. 2018

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Background: Several studies have shown the beneficial effects of mastery learning of a simulation-based course, but not all trainees complete it. Objectives: The purpose of this study was to find deciding factors for the completion of a simulation-based mastery learning course with distributive practice in flexible bronchoscopy. Methods: Seventy-seven trainees who signed up for the course were invited to a survey for deciding factors of completing the course. Sixty-two (81%) trainees answered the survey. Results: Male trainees were more likely to complete the course. The most important factor for completion was clinical relevance, and the most important factor for not completing the course was being “too busy.” Conclusion: Several deciding factors for completing the course were identified. Successful simulation-based mastery learning courses should be clinically relevant, and the trainees should be provided protected time to complete the training. The instructional design should also be adapted systematically for male and female trainees to achieve the necessary competencies.

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“…2 For example, working more frequent on-calls (either at weekends or during the week) was associated with increased psychological strain and work-life interference, while being restricted to only one rest day after working nights was associated with greater fatigue. In support of the EWTD stipulations, we found that working Ͼ48 hours per week and short rest inter-shift intervals were both independently associated with increased fatigue.…”

Section: Andrew Rl Medfordmentioning

confidence: 99%

“…Indeed, recent research into the use of reliability suggests that the standard error of measurement may be a more appropriate metric. 2 Nevertheless, it is reassuring that in nine out of 11 SCE diets to date reliability values have exceeded 0.8.…”

mentioning

confidence: 99%

European Working Time Directive (1)

Medford

2010

Clinical Medicine

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The impact of junior doctors’ worktime arrangements on their fatigue and well-being

Cited by 65 publications

References 22 publications

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

Simulation-Based Mastery Learning of Flexible Bronchoscopy: Deciding Factors for Completion

European Working Time Directive (1)

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